Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MB27483 | NJ |
NPI | 1184692261 |
---|---|
Provider Name | Michael Elliot Beams |
First Address | Clark, NJ 07066-1640 |
Second Address | Clark, NJ 07066-1640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E06173 | (02) | NJ |